Provider Demographics
NPI:1639170210
Name:DOMINGO, MINERVA (MD)
Entity Type:Individual
Prefix:DR
First Name:MINERVA
Middle Name:
Last Name:DOMINGO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 RESEARCH PL STE 320
Mailing Address - Street 2:
Mailing Address - City:N CHELMSFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01863-2455
Mailing Address - Country:US
Mailing Address - Phone:978-256-1858
Mailing Address - Fax:978-788-7890
Practice Address - Street 1:20 RESEARCH PL
Practice Address - Street 2:
Practice Address - City:N CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01863-2454
Practice Address - Country:US
Practice Address - Phone:978-788-7307
Practice Address - Fax:978-788-7890
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA157601174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1639170210OtherFALLON
MA3189198Medicaid
MA1639170210OtherBMC HEALTH NET
MA1639170210OtherHEALTH PLANS INC
MA157601OtherMEDICAL LICENSE
MA1639170210OtherUNITED HEALTHCARE
MA1639170210OtherTUFTS
MA1639170210OtherGREAT WEST
MA1639170210OtherCHAMPUS/TRICARE
MA37371OtherHEALTHY START
MAJ19862OtherBCBS
MA1639170210OtherCIGNA
MA45016OtherFALLON
MA136878OtherHEALTHSOURCE
MA131062OtherHARVARD PILGRIM
MA157601OtherTUFTS
MA1639170210OtherPHCS
MA2636907OtherAETNA US HEALTHCARE
MA0025776OtherNEIGHBORHOOD HEALTH PLAN
MA1639170210OtherHEALTHNET OF CA
MA981061OtherNETWORK
MA1639170210OtherFALLON
MA1639170210OtherTUFTS